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HomeMy WebLinkAbout020-1395-59-000 (3)V cn ~ ~ Ca' v \ ~ N ro ~, r .~1 ~ ~i I I I I ~~ v y o 3 ~ ~ can o. ~' m H ~ C N p ~ ~ ~ C. ~ O a ry = O ~ tD V G i m Cn Z D N cp D ~' I ~ a W I ~ O~ .. L ° O TI ~ y c ~ ~ ~ o m ° = N I o _ I CD N -~ ~ a a I Z a 0 I ° v ~ I ° ° Spa ? -~ A ~ ? ~ / - M C i W ~ yl..~ y j o m ~ °_ S~ v ~ ~ v\ JyO 3 N I w G p ~ I ~ ` ~° C = .'g ~ am _ j `° o I I ~'c~no°i o o m ~A ~°~ ~' o D I ~ m ~ a`~° ~ s~ m n~i~ ° a :.. (~ I ~ o ~ ~ m ava, ~ v=, x~ ~ v ~?~v=i-°pajm~o=ao < _ C n N (D ~ (O Q~ S° _? N I o aw = v m ~~ ~ ~~'~ omy ~ mn~3 I °-o ao 0 0 ~ ~ aQ _ (D O N W Q (D d S N C`1 < ~~~ ~,~ _ c ~ a-.,W ~ m 3 a. ~ocv,~awm°:E. A~ I ~~~°=c°oA°~° '~ ~ C ~ ~ ~ N ~ ~ _ ~. N 7 ~ N ,1 N a ~ T T' ~ ~ 1 I O i f7 U! O !, ?+ '~ (7 ~ 3 ~ ~ ~' ~ 3 :~ ~ '~ O W p~j C CNJ1 N `C rn~.i y ~Q C _ '~ O N ~ ~ C~j1 CEO N '', ;, y W O ~ ~ N N S ~ r. C d W n ! 'O ~ - ~ ~I A .°.~ ~ ' a ~I =i N O -+ N ? I ° !, 3 ~ ~ 0 ~ _ ~' C ~ a ~ ~ I, cn cn cn ~ ~ tO m ~vv,- 9 ~ I = m _ w •• ~ A N 3 ~ o m rn M C OD Z ~ o ~ ° m ~ c~ ° i N ~ °- !f ~ O D = I A ~ ~ a ,. i (A -~ N coo A m ~ cn -. ~ Z e 3 A ;~ z A o ~ ~ yZ I,~ f ~ c ~' I i Ii i it A I` V 0• O 0 ~• A A ti A lv O A O ti N Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and'Building~)ivision INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Carria a Homes Inc. Hudson Townshi CST BM Elev:/~ n Insp. ~~ v: U BM Description• ' / TANK INFORMATION ~ ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic ~ /~ Dosing Gf~ ,~~~~~ ~/!~(./ ~7/f Aeration Holding TANK SETBACK INFORMATION TANK TO P/L , ~ ~ WELL BLDG. Vent to Air Intake ROAD Septic t Z ~ (~ r 1 ~~J() ~ ~ Dosing Aeration _ .,-- _ . - Holdi PUMP/SIPHON INFORMATION Manufacturer GPM Model Number TDH Lift Friction Los System Head TDH Ft Forcemain Le Dia. Dist. to well "~~ County: St. CrOIX Sanitary Permit No: 430619 0 State Plan ID No: Parcel Tax No: 020-1395-59-000 Section/Town/Range/Map No: 25.29.19.2453 STATION BS HI FS ELEV. enchmark l'' 8 ~ ~ r Q O ` Alt. BM ~~ (tip / Z / Bldg. Sew r - j -- - SL(~ /a' ~ ~ /0/. / ~ t/ t Inlet /D ~ • ~ ~Q. 3 St/}it Outlet , (~ / s Z, „ f~ s. 2 / ~ . D Dt Inlet _~ ~.~ Dt Bottom i `_~ Header/Man. ~s 6'~ , ~ ' -~- ° is q9, ~ l Dist. Pipe 2 I ~''I I Z ~ •~• 9~ 9 q. ~ eot. S te~ r ~ A Qo % 0• Final Grade IZ~ 8 ~ " 3 , Z D fig. St Cover ~ ~/~ ~~ ~~ .! ~~9~ ~O ~~ •~l ~ h Pit/ ~TLLP/~/ I'~/-S ~~~ ~r SOIL ABSORPTION SYSTEM /l)~i.~,fr0~ a L"-cr,~1~ .~/~.(J~Qf l h.S~~Ct,~-~G~ -~ G'4`7~~~V7'n ~a~-cr~S ~'~A! IV ~~ S BED/TRENCH DIMENSIONS Width I ~ Length Z ~ ,S o. Of Trenches PIT DIMENS NS No. Of Pits Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO P/ BLDG WELL LAKE/STREAM LEACHING CHAMBER OR anu er b 7 ' Ty Of System: ~ ! _ I ~~ ' ~ ~ I S ~ UNIT odel Number: DISTRIBUTION SYSTEM C ~ f Q ~ ~- I ~~ ~ oZ~` ~ C~ 412 -S~~G:,-, Header/Manifplc~ k `'~ ~ Distribution ~ ~ Pipe(s) ~ ~ / x Hole Size x o e pacing to Air I ake Length _ Dia Length_t~_ Di Spacing~Q {' SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over / Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center ~i Bed/Trench Edges Topsoil ~~ Yes No `_, Yes ! , =j No COMMENTS: (Include co~ie~repencies, persons present, etc.) Inspection #1: ~ /~/ ~' Inspection #2: / / Location: 757 Hi hlander Court Hudson, WI 54016 SE 1/4 NW 1/4 25 T29N R19W Scenic Hills Lot 59 Parcel No: 25.29.19.2453 1.) Alt BM Description = IQ~ d~~~?,f/n. `~/( ,~,(/,Ly ~ y7 ' " "" ` t ~s l'"'~G/~% ~l~/~ / ~/ ~'V ~S 2.) Bldg sewer length = ~3' (~~tE~~~+ JWt~K. ~~{jZ;(.~h'.~~ ~ ~U fiR. ~/ ~-P/~- ~ ~~ - amount of cover = „ ~,r,~0~"„~ -„ - i c ~ ~ ~ ~~ s/~~j~~~ p I~ ~- Civ v.t- ~. u LC(~i`v G~~ii!~--~ ~f~j~~ ~~~ p _y,, r --~ ~ r ~ ~ q ~,~ ~ Use otherlside for add tional information. No L ~ L-- -------------_- _ ~---~- - -I--- SBD-6710 (R.3/97) Date G~~~^~ " Insepctor's Signatur~L~`' ~/~ Cert~~ cf~~~(i ~~ /! C.Glit Safety And Bttitdittgs Division Caurrty i ~ 20! W. Washington Ave., t'.U.13nx 7(182 ST. CROIX ! J~~~~~,~ iNadi scin, W i 53707 - 70$2 SaeiitAPy Permit Number (t0 be filled in by Co.) (sc>$)2F1~~ 30 Department of Commerce _ Sanitary Permit Applica.ti n REC s~~ P'a" I.a. Number lxi aoarrd with Ccmari 83.21. Wis. AdQe. Code, per>~mal intixn-at-on a provide nn fn1 2 d~ h lti ' UU j may tie tiS'~t! fvf secxx>iiary purposex Ynvacy Law, st ~.U4(t m) 1 $ DEC ng a ess) an ma r~ Address of dlfferera t t C"r i • 7 HIGHLANDER I. Appticatiittta Infarma?;~- Pic>;se Ptaat At! Infermataott ST CROIX COUN ~ . OFFIG Prtipa'ty (.lwuer's Natise Parcel ~ Lot # 59 CARRIAGE HOMES, INC. 604 ______ ..__.._ 3'rtipialy (levrirx's Maitmg Aadr~ l oil I 12415 - 55TH ST. NO. __ _ SE y,, NW ~;,, Seclioii 25 City, Stag:: 7•ip Code Phvnc Number ~ (r~irrle nna_) LAKE ELMO, MN .._ _ 55042 T 29 N; R19WE;ar~tr IL Type of Building (check a!! that aPPty) ~~ i a 2 FArrdly Fhvelting - Nursrkux of"$etirvorris BDRMS PER SUBMITTED HOUSE PLA S"~`~'s""' ~~ CSI~i ~'~ --- - ^ F'uliliGCtxin~rciai -Ih~.riliel;~ SCENIC HILLS ^ State Qwncxl-F'kscribc tTsc ~ ~ ^City__~.~ViEt~e [~t'owivtihip of HUDSON i -- -- III. Type of Permit: (Check only lure lxis on li»e A. Complete line B if wpplicnbk) D 20 - ~ 3 q S ^ = O'tTa_ l• 2.- A. i~ New 5yst~erri ^ ltaplauemetII Systaett ^ TieYalntetitfiFvidingTank 22eplac~mixi! (kiiy ^ (?flew Mvdificaticnrt io l~xis'titig System I - 8. --- _. ............._____-~~. 1--i Yeimet Kenewat .Y ........._._ I~ Yerrnet xevisrcNi ^ l.'luu-ge of {~ Penitit TrAri~es to New ~~ Previoas Permit Number' And F3Ate F tktixe Expiration Phuriber C74vnet IV. - __ _. T e of rNOWTS S tem: Check all that a i Ntxi -litc~rrired ln-C3rvittid U 5~fctund %• 24 in. ofsaitatile soil ^ Moline! < 24 its afsuitabie soil ^ A2-Grade U Single Pa.4s Sard Fiher ~_~ Cnlvtructed Wetland ^ I'ic~utced ln~;,rairrd L_I IloEdiz:g TaPdc ^ Peal. Filter ^ Aeaabic'l re~mcYk lleiit ^ RecirtailAtaig Sand Filter ^ Rt'Y iPi9ilAtlri$ RyiitllP.tiL` tellE'siiA. Fi~tY ^ l eac6lii ber i ~ t)ilji FArtZ ^ C7i'dif6l-lt'SS Pi~7l: ^ ()liter tergiiainl V. Din rsatYTrcatmcnt Area infcrtwnati . 2- 7.5' Trenches w 14 Bio Defuser chambers ea. trench total chamber Zabel A100 Tilt DesigII Fiver (gp31 F)esiign Sail Applirrdion RAte(~Sf) lJispi~rsal ltegaired (st) F)RSI Area Pivpoeed (xt} S i eeetiil~il 600 .7 857 1050 98.91 ~'" YL 'li"auk Infa Ct~iacily in Tina! Numt>~ Main-facturer PrefAb Site ex:l Fiber Q :tsliC Gaiiorai t:alMrrx of l inity C:cmcxete CanstrucKc1ti Ciiass New Existing T-u~4cs Turks s~i~~PflAla,vgT~ x 1250E 1 WIESER X ~erabic 3}oalment L7nil ..... _ _ T?rt¢rM t'ftainticr VII. Respanaib4lity Statrettt- i, the emilerai=ned, iieauroe for feFms ot'the ~VV7'S aho+nr ew tlwe athc6ed pirrri,. Pluireher's ?`tame (Print} P iMPRS Nercnbcx 134wineac l~sn+>e Number TODD FEATHERSTONE 242514 715-381-1704 I'iumirer's Addres9 (b'ire+el, City, SiArc, ' C:acic} P.O. BOX 467 HUDSON, WI VIIL Cauca !De artment Use Onl T___. ~;~pprovad ^ Disapproved Permit Fee (includes t3sounawater Date Fsseied Fns ing Signature (No } ^ O Given Iteasvn for I)etsial IX. Conditions of APPrnPal/Keasotts for Ifisappmval _,j_~ 0~ c~ SYSTEM OWNER: ~> ~''^~ a~Q ~~ U V 1 Septic tank, effluent filter and ~~- ~ ~~ _ _ . _ _ __ (~ ~1 n /t n ~-S -~ dispersal cell must ail be serviced !maintained r.-- '~°'~'~4/ a-YbL Jas V as per management plan provided by plumber. (~' _ ~~ ~~ 5 i `_ f 2. All setback requirements must be maintained ~- "[~ as per applicable code/ordinances. ~---~---~ .lttacti ramti9efe places tin tie Camty mi(x) ror tl~ ay~em eel paper rice! kss than (lilt i 11 iaches in si¢e •'-w-`~ • ~i -- ~~ ~ L ~ . ~, ~ °~ ~~ ~ .. o ~~, g~ - r Q •ovi " ~, ~~ ./ . i w ~, cis ~~° - ~ ~ ~~' ~~s ~• ~~l ~ ~~ %,~ lw ~ ~ ` g~ _ Gt~,.~-~ dam' ,,r, _~ . ~ - ~,. - .~ ., ~~ ~ to ~~~ ~' ~°~~~~ ~; ~. ~~ w~cori~n Department of Commerce - SO{l EVALUAT{ON REPORT Division of Safely and Buildmgs Page ~ ~~ m acoor~oance wrm wmm ~, vns. rwm. was - ~'' ~ t I S C o ~ Attach complete site plan on paper not less than 81/2 x an mus 1 ~e.,p indude, but not limited to: vertical and horizon~l refers percent slope, scale or dimensions, north arrow, a (. _);~see® and nil distance to nee road. Parcel I.D. 0 Z ~ ~ 3 ~ S ~ S - ~Y.~ . "~. .Please print all i }~ n. ,,}yy~~ " Date y Personal h~formation you provide may be used for n -purposes (Pr~Mie~y:s.15.04, E!~ m)).. ~ G` ~ ! Z D Property Owner ~ --~ ~ ; ~" ,; ~~ tbn Props ~~ ~~ww ~ --' .]CJ ~ . s~- ~ ~ ~.- LQ~ ~' E 1/4.Uw 114 S ZS' T ~. y N R ~ E (or) Q Properly Owner's Mailing Address _ : ~-'~ ~ , Urv,7, ' Lot , # Subd. Name a• CSAAi~ CO ~ Z. O S ~ i ~ ~ (.vu~ r~ ~ ~ ~ ~ t~r Vr~ ~ ~~rt=~` ~ S e t ~ . City State Zip Code Phone ~. ' dy ^ Vdiage (,~ Town Nearest Road ~Srti'Ilw«-fir VNrt. z;'S'o~Z. ( ~'!~ ~~ r. , r n^ . Q . . ®New Constnx~on - Use: ® Residential / Number of bedrooms 3 _ ~f Code derived design flow nee DSO ~(o O O GPD ^ Replacement ^ Pi~lic or oommercrcial - Descr~e: Parent material Ov fc.JaS I.. Flood Plain elevation if apprcabie ~/i`~ tt General comments S S ~ rvl e. (e ~a. f .b /~ _ . So /Dd • 9 ~ •~ Q-f /63. `~ ~•~ / and recommendations: ~ ~~ ~ I ,~~ 0. ~-.b ri - .q~-~ - ~~!~ _ ~ f D ~ ~l,P",6ele-r/ sup-.~-~ _. - SLn Boring # ^ Boring Ground surface elev. 4'U ft Depth to limiting factor ~ ~ ~-° in. Pit ~~ Sod ' n Rate Horizon De th Dominant Cob Redox Desdi~ption Texture Stnrdure Consisberwe Boundary Roots GP D/fF p . in. Mansell Qu. Sz. Cont Cobr Gr. Sz. Sh. 'Effay'I •Eff#2 1 C-IZ 1~ i 3~Z ~ I Zrr-r~bk Yn~r LS 1v ~ , 5 , ~ 2 1 Z - Z~ 1 L ~ r' ~-f ~~~ --- Si ~ 2: b k vY, ~r c s - . 5 ~ ~`{-illy ~ l~~ i y~~ ~ ~~~ b 5 ~ mC - ~ . ~ I . Z lr ~ - ~ • ~ 98'•9~~ ~~ ~ Boring # ^ soring _ ' ®Pit Ground surfaoeelev. /aZ ~ .~ ~. Depth to leriiting factor ~ ~U in. ~ Rabe Horizon Depth Dominant Cob Redox Description Texlun: SWdure Consistence Boundary Roots GP DJtP in. Mansell Qu. Sz. Cont dolor Gr. Sz. Sh. - 'Eft ;ER#2 0--I ~Q,_ 3 2 _ r.I Z k. .. -~~ cS Ivy . 5 ~8 2 r~ - 34 ~ ~ ~~1 /~l 5~~. f Z~~bk m kr ~ - ~ 5 ~ ~ ~~ ~ - - 1 ~-~~ .o ~ l.o * EfRaent #1 = B~~_ ~ ~ < 220 mall and TSS >~ < ~ ~ rr-olL ' Ettii,ent #2 - BOD . ~ ~ mglL and TSS ~ .~ mglL CST Name (Please Print) lure CST Number er^ zs3 30 9' AddrESS Date Evaluation Conducted Telephone Number z~i3 0~- ~~• So~~se-f wi. Yoz.s~ ~-~-~~ ~~S -zy~- LIB 8 Property Owner r k~ ~ ~ _ Parcel ID # Page z of,~ ® Pit Ground SUflaCe elev. o/ ~ `~d ft. ~pth to 1~!~9 ~~' IT in. Soil lication Rate ~~ # U ~~ Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft~ in. Mansell Qu. Sz. Cont Color Gr. Sz Sh: 'Eff#1 'Eff#2 IZ y , fly -- Si ( 2ma 1 ~r _ _ ~ 3 ~-i(~ I ~~-yl ~ - - r»5 ~ ~5G ~~~-,I ~-- ~~ .~ I.Z 3 ~ ' `~~,9 1' 5`l ~ °~ -~ ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Sod. ication Rate Horizon Depth Dominant Color Redox Description Texture Struc~uure Consi~enae Boundary Roots GPDA~ in. Mansell Qu. Sz. Cont. Cobr Gr. Sz Sh. 'Eff#1 'Eff#2 Boring # ^ B~ _ . ^ Pit Ground surface elev. ft. Depth b limiting factor in. Sal icatbn Rate Horizon Depth Dominant Cob Redox Description Texture Structure Consistence Boundary Roots GPD/f~ in. Mansell Qu. Sz. Cont. Cobr Gr. Sz. Sh. 'Eff#1 'Eff#2 'Effluent #1 =-BODE > 30 _< 220 mglL and TSS >30 <_ 150 mg/l. ' Effluent #2 = BODS <_ 30 mglL and TSS _< ~ mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R07/00) .r PAGE ,3 OF~_ NAME 14 r 1~-e- ~ ~ LOT#~ q LEGAL DESCRIPTION S E '/< ~'/a S Z5 T Z4 N,R !`t E (or~ »- v y SCALE: 1 - BM I ELEVATION loo • ~ BM 1 DESCRIPTION {r, p a -~ t~• p v c.. P: P c '~ BM 2 ELEVATION 9 g. ys BM 2 DESCRIPTION -Fu A o ~ (~~ P Jc• P ~'Q e. SYSTEM ELEVATION 9 4• S ° ALTERNATE ELEVATION R4. 5 ~ I - -{- X ~ 2.5 C o •o ~~ S ~.~a z v s (~~l`~k ~ 3MZ s' `~ _Z c~ ~ ~ "~ ~~ `° ~ . 0 ONTOUR ELE NATION to Z v ¢ 3 cs (o Y ~~~= ~~°~ ~; -- _. ,~ ~ 2`I ~ / _ - / 5~ 6-3 ~ _~ •{> f __~,_- ~ X -~ o ~ X ,a~ ~i _ n, w A ~ ' V v ~ r _ _ ^' ~ O ~ ~~ ~ 1 ~ A~ ~\~ A - og j C~ ~ \, a u+ ~ i ` ~ i ~ i \ \~ ~~ 1 °~° V f-~- D - ,` ~ X __~-___~___---c`~ o ~ \ ~ ~X ~ ~ ,-----~ ° - ~ ~ c~ ~ J ~w d A ~ ~ ~ - / /1 0 9Z~ °X Xw ~a, _ O y ~ `° oM~t o O q~i" `1 ' ` Y c,+ E N X - o J O~ XA W , r J ~ u b~' ° x . ~~ / w ~ m x ~~ ~~ - X o O _ / ~~ J . O 1 Fem. ~ - o ~ ~ ~- s ~ ~ t D vw n n x X .L 0 ~ o ~ 11~f1 A 1 1 ~ ~ x c~0 Q~ ~~ ~~ . ~ ~ v ~~ .;\ .~ ~~ O N -- iS X ~"~ _ s SYSTEM CROSS SECTION CARRIAGE HOMES, INC. 757 HIGHLANDER CT. SCENIC HILLS, LOT 59 MAN HOLE INSPECTION PIPE GRADE E- ZABEL FILTER 1250 GAL. 87.5' . - ---~ ~ ~~~ I SYSTEM ELEV. 96.33 _~ ~ ~ 9 ~ ~ 14 BIO DEFUSER CHAMIl~FRS ~ O O ~_.._......__.~_ 87.50' 0 14 BIO DEFUSER CHAMBERS _ ____ pip .fit 648604 SE +/. NW y,,S 25 T 29 N,R 1~Y11E f`©T 59 g~-~ SiJg SCENI,! CHILLS IC MPRSW 242514 ._.~- POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 1 of 2 FILE INFORMATION OwnerCARR1AGE HOMES INC. Permit # ~ DESIGN PARAMETERS Number of Bedrooms 4 ^ NA Number of Public Facility Units ^ NA Estimated flow (average) 6 al/da Design flow (peaks, (Estimated x 1.5) gal/da Soil Application Rate ~ al/da /ft~ Star>t~ld Influent/Effluent Quality Monthly average' Fats, Oil & Grease (FOG) 530 mglL Biochemical Oxygen Demand IBODbI 5220 mg/L ^ NA Total Suspended Solids ITSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand IBODS) _<30 mg/L Total Suspended Solids (TSS) 530 mg/L ^ NA Fecal Conform igeometric mean) 510" cfu/100m1 Maximum Effluent Particle Size Ye in die. ^ NA Other: ANA "Values typical for domestic wptawater and septic tank efflusrK. SYSTEM SPECIFICATIONS Septic Tank Capacity a) ^ NA Septic Tank Manufacturer ^ NA Effluent Filter Manufactur ^ NA Effluent Filter Model ^ NA Pump Tank Capacity al ^ NA Pump Tank Manufacturer ^ NA Pump Manufacturer ^ NA Pump Model ^ NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration O Disinfection ^ Peat Filter ^ Wetland O Other: ~',~IA Dispersal Cell(s1 ^ In-Ground (gravity) C~ At-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other: Other: ~A Other: $~ NA Other: ~ NA •~w1~ITC~lAA1f~C CPLICr~l 11 C Ir1f111~ 1 GI\M~wr VV^,L.VVVv Service Event Service Frequency Inspect condition of tanklsl At least once every: ~ month(s) (Maximum 3 years) ~ earls) ^ NA Pump out contents of tank(s) When combined sludge and scum equals one-third IY3) of tank volume ^ NA Inspect dispersal ce(lls) At least once every: 3 ~yearlslis) (Maximum 3 years( ^ NA ^ month(s) ^ NA Clean effluent filter At least once every: year(s) ^ month(s) ~ NA p p p, pump controls & alarm Ins ect um At least once every: p year(s) Flush laterals and pressure test At least once every: ^ month(s) ^ year(s) ^ NA Other: At least once every: ^ month(s) ^ year(s) ~NA Other: c~NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tanklsl to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal ce(lls) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third iY3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of s12 months, shall be performed by a certified POWTS Maintainer. 1 A service report shall be provided- to the local regulatory authority within 10 days of completion of any service event. GMW (4101) Page 2 of 2 START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may filE above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal celllsl in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain sump pump{ water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. ~ After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWT5 fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ^ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDlOR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name ~pr Phone 7~ ..- ~d-(~ vnWTS MefNTA1NER Name FEATH RST Phone 715-381-1704 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name pINKI('S Phone 651-436-5788 Name ST. CROIX COUNTY Phone 71 -3 - This document was drafted in compliance with chapter Comm 83.221211b111-Id-&(f) and 83.54(11, 121 & (31, Wisconsin Administrative Code. s~r cr.ul;~ cv~.~1r'r'i~ SEPTIC TANK ,-~,AiNTENA,~ICE AGP,EEIviEN7' Ai~iD OW'v'E:;S:TIP CERTIrICATiON I~{3R.~vi Or~•ncr/l3uycr Carriage_Homes XXI, Inc. Mailing Addr~.~s 1 241 5 55th Street North, Lake Elmo, MN 55042 Property Address City~State (Vc;ifi„ation reQUi:rd from Planning Dcpartmcnt for new Wisconsin Parrzl Identification Ntunber 6 4 8 6 0 4 ~1FGAL hESCRTPTIQ~` - See Attached Legal on Deed / ' / Sw'/y Property Location /~/l~/ y~, N y~, Sec. ~ T~N-R~,W, Town of ~~l.C rJSly'l~ . Subdivision Scenic Hills \Lot ~ ~. Certified Sarvey hSap # . L'oltrme ~-'Page _ _ - - ' e4'tttTanty Dared # 6 4 8 6 0 4 . Voltrrntr ~ Pagc # Spx hatise ^ yes ~n~ I.ot Imes identifiable ~ yes ^ no S'YS~M ~iALT~i'I'i(;I~IAIdL;E Imlxuper use sad ra3.inLeaaacr of your scpsic xystem could rrsult m its l~failgre to lyuldle wasics. Proper ^-~ *-^-~n+~ *+~r coasis~ of pumping out the septic tam every t'.ute yeazs or sooner, if needod hY a Iiceasod pumper. What you put into the system can affxt the fime>iaa of the tcptie fault as s treatment stsge is Sye Este dL try. I systzm. Tha property oWacr sgrzes to cubmii to St Ckoiz Zoning Dcpartmeat's txrtificasioa fotm, sig~cd by the o~xncr. and by a n~stcrptumber, joumeyinan p r~ttided plumber or:liccas.^d pampa vcifyz~g tlsat (1) the oa-site ~zstcwatcrdisposat systan is in proper operating condition andlor (2) aRer iaspoctioa and pumping (if necessary), tae septic tank is less than 113 foil of sludge. Uwre, the nndasigaed h:ve mad the above rageuremeats and agars to rr2intaia flu private scwagc disposal syxtcm ~ '' the standard: tat forth, btreia, ss set by tae Dcpa~nent of Commerce aad the Dcpattmeat of ?~atzual Resources, State of Wisconsin. Ccriification stating thst your septic system has boea tnaiatniacd tassst be caiuplrscd and returned to the St. Croix County Zaaiag Office within 30 days of the thnce year ezpisa~oa daft. SIGKATURE OF APPLICANT DATE OWKER CERTI~'ICATTON I (we) certi.Fy tali staiemcrltx on ahis form a.*r tnu to tht t,cst of my (oar) )ruzowiedgc. l (we) am (r*~) tsc o~~nc-~;s) of t3ie propezty din vo, by virtue of a Rzrar,ty deed cxo~ed in ~egist~r of f3:tds Offu. / , ~ 03 S 'It~i~~?'PLICA2~"£ DATE ..~_. ••«••• ~, iaforma+ioa that is atis-riz^,.scatcdr~y r~.i?t is t:ic saaita.~y pctnvt bcits rcvoE:~+ by tsc Zo^iag Dcpa.~cnt_ s+r.• • Ladudt wtth tisis sppti;.xtiQn: a s:r.^,Zpcd wa.^.anty d~ frors tti~c Fcgisttr of Deeds office a campy of sire certited r.L-vcy uup if r: fcrcncc is ~.ade in the wanarry decd I ~t ~ ~ DOCUMENT NQ i ~_, ~ ~. r: 1 ~ i 1 I -t_~--____ c_ ~~~ ~o ~ WARILANTY DICIDD 6TATE OF WISCONSIN-FORM 9 Ili TNIi iPAC[ RLiERVCD POR RaCOROINO DATA THIS INDEIVTCTRE, Made b RICHARD N. PEARSON and JEAN M. PEARSON, husband and ~ife, graator. S.. of.._.St :.. Croix----------------••---------•---....--•-•----............County, Wiscoaua, CARRIAGE HOMES XXI, INC., a h~teb conveys and warFants to........__.._..._.._........... -------.-----.-•------- Minn~sota corporation, ....... i S~ .. _....---_ .__._.._.._ ...................................................... ~ rautee........ of ~ ~as5ing~On ..County, I~k'i~~2i or the sum of ~pyr~~~Q_~Qplyl~~'r}_.7_an^d.. no110 0...-(~ 1.00) ,._and.. othe r.._good.- and., va luable._. Y.li/ilt~F~X.145f1~CRQ:l ............................................................................................................. RETURN TO ..... the following tract of land in...-,~t.....~~Ql~C ................................................County, ' A1.1..4~...thy.-.N9~.thWgS~..4u~.rte.r...~N.'r?~i)`...and...Nor~h..llalf (N~) of the Southwest Wisconsin Quarter (SW~) of Section Twenty-Five (25), 'Ibwnship Twenty-Nine (29) .North, Range Nineteen (I9) West, St. Croix County, Wisconsin, except IAt One of Certified Survey Map filed June 29, 1994, recorded in Volume 10, Page 2782, St. Croix County Register of Deeds, as Document No. 518444. ;~ .=`. '~ 117-M-C r ration Minnesota Uniform Conveyancing Blanks (1978) Miller/Davis Co. ° St. Paul, MN 651-642.1988 ~'I'ATE OF MINNESOTA ss. Affidavit Regarding Corporation COUNTY OF ____ _ __ _ -- ----._ -- and being first duly sworn, on oath says(s) that: 1. ('T'hey are) (._ he is) the __ ___ and the ___ _ .. --- _- -- __--~ -- - -. respectively, of _ Carriage HomesxXl, lnc-. _ __ `_ -;_ - _- _ __ -- -- - a _ _ _____Minnesota_ __ ___-_-_-. ___- _ corporation, the corporation natned as _ - ----- -- - -------------- --- ----- - . ---- _ __ in the document dated - ,and filed for record __ -_ ------ - - --- ' as Document No. - - _ - (or in Book -------- of ---------------- -----------_ -- - Page ---_--_-__ _- __ - ---- _ _ . __ _- - .-- ---_ .-) in the Office of the (County Recorder) (RaE~k~t~~ __ _ __ St. Croix_ _ _ __ __ _ County, Minnesota. of _ _ 2. Said corporation's principal place of business is at _ __ _ _ __ _-__.______ .___._...-__ ._._---.. --_-.._---- -- - and said corporation's previous principal place(s) of business during the past ten years (has) (have) been at: 3. There have been no: a. Bankruptcy or dissolution proceedings involving said corporation during the time said corporation has had any interest in the premises described in the above document ("Premises"); b. Unsatisfied judgments of record against said corporation nor any actions pending in any courts which affect the Premises; c. Tax liens filed against said corporation; except as herein stated: _, ,~ Z 0 ~~~ 8~~~ .~ ~~~~ 8~~ ~~o Afl ~ W ~ ~~ ~~ ~ ..._~ -- ~~ Y ~~ ~~ ~~ a~ ~~ ~ ~ • ~ ~ ~ ao ' ' -~ -_ Y ~ _ - -- ~~ ~ ~ ~~ ~~ ~ / ~~ Q~ ~~ V ~~ \`~ ..1~~~ w ~ ~ ~~ _ ~~~ ~ ~~ ~ V ~~ ~~~ ~~ ~~ ~~~ ~~~ ~~~ ~~~ 3ri,OpppS yVdp O1 WMfIISbY,SZ NOLL~3S d0 NIMN 3H1 d0 3N'11S3M 3HL Ol ~13!l3~N 3yy. ~~~